<?php
/* @var $this NbnorderController */
/* @var $model Nbnorder */
/* @var $form CActiveForm */
?>
<div id="update_form">
<!-- form start -->

<div class="zyWell">Fields with<span class="required">*</span>are required.</div>

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'nbnorder-form',
	'enableAjaxValidation'=>false,
)); ?>
<?php echo $form->errorSummary($model); ?>

	<div class="row-fluid">
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'phone_connection'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'phone_connection',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'phone_connection'); ?>
					</div>
			</div>
		</div>
			<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'phone_number'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'phone_number',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'phone_number'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
	
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'contract'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'contract',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'contract'); ?>
					</div>
			</div>
		</div>
				<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'need_modem'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'need_modem',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'need_modem'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">

		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'phone_line_rental'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'phone_line_rental',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'phone_line_rental'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'installation'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'installation',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'installation'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'eset_security'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'eset_security',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'eset_security'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'home_phone_handset'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'home_phone_handset',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'home_phone_handset'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'modem_data_offer'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'modem_data_offer',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'modem_data_offer'); ?>
					</div>
			</div>
		</div>
			<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'title'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'title',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'title'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
	
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'first_name'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'first_name',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'first_name'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'last_name'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'last_name',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'last_name'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'birthdate'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'birthdate',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'birthdate'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'account'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'account',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'account'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'account_text'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'account_text',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'account_text'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'phone'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'phone',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'phone'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'mobile'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'mobile',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'mobile'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'email'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'email',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'email'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'confirmEmail'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'confirmEmail',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'confirmEmail'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'delivery_radio'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'delivery_radio',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'delivery_radio'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'street_number'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'street_number',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'street_number'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'street_name'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'street_name',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'street_name'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'suburb'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'suburb',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'suburb'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'type_state'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'type_state',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'type_state'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'postcode'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'postcode',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'postcode'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'pay_method'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'pay_method',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'pay_method'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'card_type'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'card_type',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'card_type'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'card_name'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'card_name',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'card_name'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'card_number'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'card_number',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'card_number'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'card_type_month'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'card_type_month',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'card_type_month'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'card_type_year'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'card_type_year',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'card_type_year'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'cvv2'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'cvv2',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'cvv2'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'account_name'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'account_name',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'account_name'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'account_number'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'account_number',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'account_number'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'bsb'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'bsb',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'bsb'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'overseacalls'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'overseacalls',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'overseacalls'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'smartTV'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'smartTV',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'smartTV'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'customer_source'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'customer_source',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'customer_source'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'order_status'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'order_status'); ?>
						<?php echo $form->error($model,'order_status'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'setup_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'setup_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'setup_fee'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'modem_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'modem_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'modem_fee'); ?>
					</div>
			</div>
		</div>
			<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'month_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'month_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'month_fee'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
	
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'delivery_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'delivery_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'delivery_fee'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'installation_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'installation_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'installation_fee'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'eset_security_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'eset_security_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'eset_security_fee'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'home_phone_handset_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'home_phone_handset_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'home_phone_handset_fee'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'modem_data_offer_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'modem_data_offer_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'modem_data_offer_fee'); ?>
					</div>
			</div>
		</div>
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'international_calls_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'international_calls_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'international_calls_fee'); ?>
					</div>
			</div>
		</div>
	</div>
	<div class="row-fluid">
		
		<div class="span6">
			<div class="form-row control-group row-fluid">
				<?php echo $form->labelEx($model,'smart_tv_fee'); ?>
					<div class="controls span7">
						<?php echo $form->textField($model,'smart_tv_fee',array('size'=>60,'maxlength'=>255)); ?>
						<?php echo $form->error($model,'smart_tv_fee'); ?>
					</div>
			</div>
		</div>
	</div>

<div class="form-actions row-fluid">
	<div class="span7 offset3">
		<?php echo CHtml::submitButton($model->isNewRecord ? Yii::t("common","Create") : Yii::t("common","Save"),array('class'=>'btn btn-large btn-block')); ?>
	</div>
</div>
<?php $this->endWidget(); ?>
</div>
<!-- form -->